Human Papillomavirus
Bene, dulcis in fundo ecco anche la mia ricerca bibliografica. Avevo promesso che sarebbe stata la ciliegina sulla torta caro Professore e spererei di non deluderla se non che ho dovuto cambiare argomento per mancanza delle informazioni che desideravo sul tumore al polmone (o forse per errore mio che ancora non ero molto pratica con Pub Med). Quindi volendo restare in ambito ho deciso di cercare notizie su un argomento di grande attualità che riguarda l'universo femminile innanzitutto, ma che coinvolge indirettamente anche i maschietti: l'HPV e la sua stretta relazione col tumore del collo dell'utero.
Per me era importante parlare di tumori perchè è un tema che mi sta molto a cuore. Non solo per recenti esperienze personali e perchè ho vissuto da vicino la malattia, la sofferenza, la paura, ma anche perchè sempre più persone nella nostra società si ammalano e lottano ogni giorno contro questo mostro che la Medicina stessa ha difficoltà a combattere.
I tumori ci spaventano più di molte altre malattie ed è proprio per questo che dobbiamo cercare di sconfiggerli con la PREVENZIONE, l'unica arma sicura nelle nostre mani. Vorrei sottolineare l'importanza di tutte le tecniche di prevenzione, da quelle che riguardano lo stile di vita, alle analisi e controlli periodici a cui ci dobbiamo sottoporre, ai vaccini obbligatori e non. Molti di noi ne trascurano la rilevanza ed è qui che sta il grande errore. Là dove la terapia provoca sofferenza e dove la guarigione non è una certezza è ancora più importante prevenire. Non facciamo l'errore di sentirci immortali e immuni da questa malattia, di pensare che non capiterà mai a noi. Certo dobbiamo essere fiduciosi, ma allo stesso tempo coscienti e consapevoli del valore della SALUTE. Purtroppo molte volte ne capiamo l'importanza quando questa ci viene a mancare e solo allora le diamo il giusto posto nella lista delle priorità. Ricordiamoci sempre che la salute viene prima di tutto.
A questo proposito riporto qui un articolo scritto su un settimanale dal professor Umberto Veronesi, oncologo italiano di fama internazionale.
Vaccinarsi prima è costoso, ma è meglio che curarsi dopo
Di Umberto Veronesi
"Mi sono sempre battuto per la prevenzione, e trovo che la vaccinazione anti papilloma virus, che esordisce
quest'anno per 280 mila undicenni, sia un'iniziativa di prevenzione indispensabile perchè ogni anno in Italia muoiono per tumore del collo dell'utero 12.800 donne. La spesa prevista è di 75 milioni di euro e questo è già un grosso sforzo per il bilancio dello Stato, tuttavia penso che quando si tratta di salvaguardare la salute si debba uscire dal discorso delle cosidette "priorità". È vero che le risorse non sono illimitate e che lo Stato deve fare delle scelte, ma penso che in materia di prevenzione non si dovrebbero applicare criteri contabili. A mio giudizio, i costi della prevenzione sono un investimento e non una spesa, e per rendersene conto basta confrontarli con i costi della malattia che si sarebbe potuta prevenire. È vero per la vaccinazione contro il papilloma virus (HPV) che può prevenire il tumore del collo dell'utero, è vero per le vaccinazioni contro la meningite, è vero per gli esami diagnostici come la Tac spirale che possono portare alla scoperta del tumore del polmone in fase precoce, quando è ancora operabile. Per la Tac spirale all'Istituto Europeo di Oncologia lancimmo nel 2004 il programma Cosmos per tenere sotto controllo i gruppi a rischio come i forti fumatori, e scoprimmo subito molti casi che altrimenti sarebbero arrivati all'osservazione con drammatico ritardo. Purtoppo anche la Tac spirale non è gratuita. La nostra politica sanitaria ondeggia tra una prevenzione estesa e la gestione affannata delle emergenze, come dimostra la decisione tardiva di alcune Regioni, quest'inverno, di rendere gratuita la vaccinazione contro la meningita soltanto dopo il panico creato da alcuni casi mortali. Per ora, le uniche vaccinazioni gratuite sono quelle obbligatorie (antipolio, antidifterica, antitetanica, anti epatite B) mentre già quelle "raccomandate" (contro morbillo, parotite, rosolia ed Haemophilius Influenzae) la situazione varia da Regione a Regione, con il risultato ingiusto di creare diferenze tra i cittadini. Come dice il premio Nobel per l'economia Amartya Sen, non è solo il prodotto interno lordo a riflettere il livello di sviluppo di un paese , ma anche "l'indice di sviluppo umano", del quale fanno parte la scolarizzazione e lo stato di salute della popolazione. Che migliora proprio con la prevenzione."
Fatta questa lunga premessa veniamo agli aspetti pratici. Come ho fatto a fare questa ricerca utilizzando Pub Med?
Prima di tutto mi sono collegata al sito http://www.ncbi.nlm.nih.gov/sites/entrez e ho provato ad inserire nella barra "for" le parole chiave human papilloma virus..ehm sono stata sommersa da più di 3000 articoli a proposito. Allora ho aggiunto le virgolette, ma essendo gli articoli sempre troppi ho inserito alcuni limits (added to PubMed in the last 5 years, published in the last 5 years, Humans, Female, English, Italian, All Adult: 19+ years, Adolescent: 13-18 years) e infine la parola chiave vaccination e l'operatore booleano AND.
La mia ricerca risulta: "human papillomavirus" AND vaccination. Tra gli articoli trovati ho selezionato quelli che a mio parere sono i più interessanti.
Il primo articolo dà un'idea generale dell'impatto del vaccino anti HPV sul cancro del collo dell'utero. Il secondo e il terzo articolo spiegano esaustivamente non solo la relazione tra HPV e cancro della cervice, ma anche l'efficacia del vaccino e l'importanza della prevenzione tramite screening e pap test nei soggetti già infettati. Comunque gli articoli ribadiscono che anche nel caso di soggetti vaccinati è importantissimo continuare a sottoporsi a indagini diagnostiche e non sottovalutare la prevenzione. Infine il quarto articolo è il sunto di studi effettuati su campioni di donne, atti a dimostrare la potenza del vaccino.
1: J Clin Oncol. 2007 Jul 10;25(20):2975-82.
Impact of the human papilloma vaccine on cervical cancer.
Chan JK, Berek JS.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford Cancer Center, Stanford, CA 94305, USA.
During the last decade, research progress on cervical cancer has elucidated the role of human papilloma virus (HPV) in the pathogenesis of cervical cancer. Clinical trials on the viral-like particle HPV vaccines have good safety profiles and promising efficacy in preventing genital warts, cervical neoplasia, and cervical cancer. The implementation of the HPV vaccine is a tremendous milestone in our effort toward preventing cervical cancers. However, screening programs will continue to serve as a critical component in prevention due to the limitations of the current vaccines. The greatest impact in cervical cancer incidence worldwide requires improved health care access to underserved areas. Advances are needed to develop single-dose, heat-stable, needle-free, and affordable formulations of the HPV vaccine to overcome the socioeconomic barriers associated with this disease.
PMID: 17617529 [PubMed - indexed for MEDLINE]
- 2: Presse Med. 2007 Apr;36(4 Pt 2):640-66. Epub 2007 Mar 12.
Prevention of cervical cancer: prophylactic HPV vaccination, current knowledge, practical procedures and new issues.
Monsonego J.
Institut Alfred Fournier, Paris. jmonsonego@wanadoo.fr
Despite the considerable success of early screening for prevention of cervical cancer, Pap smears have not fulfilled the hopes that it would lead to a large-scale reduction of this cancer's incidence. Screening appears to be useful for a tiny portion of the world population, although a relatively large portion must put up with its limitations and disadvantages. Human papilloma viruses (HPV) 16 and 18 are responsible for two thirds of all cervical cancers worldwide. The condylomata (condyloma acuminatum), or genital warts, induced by HPV 6 and 11 are frequent among the young and difficult to manage. The extent and burden of HPV infection are considerable, as is the psychological and emotional impact of the diseases associated with it. Because cancer of the cervix is the final consequence of chronic HPV infection, it can be prevented by vaccination. A prophylactic vaccine to protect against the precancerous and cancerous lesions associated with HPV should save lives, reduce expensive diagnostic and therapeutic interventions, and have substantial individual and collective benefits. Clinical trials of anti-HPV vaccines for the prevention of cervical cancer and condyloma have shown remarkable results and an efficacy unequaled in the history of vaccination against infectious diseases. Vaccine efficacy has been shown only in young girls never exposed to the virus and only for the lesions associated with the specific viral types in the vaccine. Preliminary data indicate that the vaccination is effective in women who have previously eliminated naturally the virus. It has no therapeutic effects on existing lesions or in healthy virus carriers. Practical questions remain to be resolved. If the vaccination is left to individual initiative and vaccination coverage is insufficient, there will be no perceptible reduction in the frequency of cervical cancer. Vaccination policies will not be identical in poor countries, where the disease represents one of the leading causes of mortality among women, and in the rich countries, where screening programs have considerably reduced the frequency of this cancer. Current planning calls for the introduction of systematic vaccination of young girls aged 9-15 years, with progressive "catch-up" vaccination of the cohorts of young women aged 16-26 years. Nonetheless mathematical models and immunogenicity results indicate a possible benefit for individual vaccination of adults. This approach must still be assessed in the clinical trials underway. Because the vaccine does not protect against all types of HPV associated with cervical cancer, screening must be continued according to the conditions currently set. Vaccination and screening, which are complementary and synergistic, now constitute the new standards for prevention of this disease.
PMID: 17350792 [PubMed - indexed for MEDLINE]
- 3: Asian Pac J Cancer Prev. 2006 Oct-Dec;7(4):683-6.
Cervical cancer: screening and prevention.
Behtash N, Mehrdad N.
Vali-E-Asr Hospital, Tehran, Iran.
Cancer of the cervix is the second most common life-threatening cancer among women worldwide and both incidence and mortality rates are likely to be underestimated in developing countries. HPV high risk strains play at least the major if not an absolutely necessary role in the etiology. The concept of cervical intraepithelial neoplasia (CIN) was introduced in 1968 as an equivalent to the term dysplasia, which means abnormal maturation. Cervical cancer progresses slowly from preinvasive CIN to invasive cancer and therefore screening for dysplasia is an important public health effort worldwide, given the accessibility of the primary organ site, the acceptability of current screening methods, and the long preinvasive period in which to detect disease and successfully intervene. It is widely accepted that detection and treatment of HPV-related dysplastic epithelial change in the form of CIN-2 and CIN-3 can prevent the development of invasive cervical cancer in individual patients. The mainstay of screening programs has been the Pap smear, introduced originally by George Papanicolaou in 1941. However, considerable numbers of false-negative Pap smears may occur with the traditional Pap technique, mostly due to sampling error. More recently, the use of liquid-based technologies such as ThinPrep and AutoCyte Prep have gained popularity, in part because of evidence suggesting reduction in the incidence of inadequate smears. It is also hoped that the ability to identify patients with oncogenic HPV types will lead to improved detection in women more likely to have squamous intraepithelial lesions. Hybrid Capture 2 is the latest refinement of HPV tests and has been described as having enhanced sensitivity. HPV DNA testing can be used as an adjunct to cytology in routine cervical disease screening programs. Establishment of the link between HPV and cervical cancer has further provided the impetus for research into prophylactic vaccination against the most common HPV types associated with the disease, HPV 16 and 18. Initial studies have provided evidence that L1 virus-like particle vaccines against HPV types (as monovalent, bivalent, or quadrivalent vaccines) prevent at least 90% of incident and persistent infections and their associated precursors of cervical cancer. This vaccine has sustained long-term vaccine efficacy against incident and persistent infections and in the long term should provide an answer to the cervical cancer problem. For the vast majority of women who have already been infected, however, continued screening and resection need to be emphasized.
PMID: 17250453 [PubMed - indexed for MEDLINE]
Sempre su Pub Med ho trovato questo utilissimo sommario che riassume tutto quello che c'è da sapere sul vaccino anti HPV..lo trovo fantastico! Finalmente un pò di chiarezza sul tema..
Patient drug information
Updated: April 01, 2007
Human Papillomavirus (HPV) Vaccine
What is HPV?
Genital human papillomavirus (HPV) is the most common sexually transmitted virus in the United States.
There are about 40 types of HPV. About 20 million people in the U.S. are infected, and about 6.2 million more get infected each year. HPV is spread through sexual contact.
Most HPV infections don't cause any symptoms, and go away on their own. But HPV is important mainly because it can cause cervical cancer in women. Every year in the U.S. about 10,000 women get cervical cancer and 3,700 die from it. It is the 2nd leading cause of cancer deaths among women around the world.
HPV is also associated with several less common types of cancer in both men and women. It can also cause genital warts and warts in the upper respiratory tract.
More than 50% of sexually active men and women are infected with HPV at sometime in their lives.
There is no treatment for HPV infection, but the conditions it causes can be treated.
Why get vaccinated?
HPV vaccine is an inactivated (not live) vaccine which protects against 4 major types of HPV.
These include 2 types that cause about 70% of cervical cancer and 2 types that cause about 90% of genital warts. HPV vaccine can prevent most genital warts and most cases of cervical cancer.
Protection from HPV vaccine is expected to be long-lasting. But vaccinated women still need cervical cancer screening because the vaccine does not protect against all HPV types that cause cervical cancer.
Who should get HPV vaccine and when?
HPV vaccine is routinely recommended for girls 11-12 years of age. Doctors may give it to girls as young as 9 years.
It is important for girls to get HPV vaccine before their first sexual contact - because they have not been exposed to HPV. For these girls, the vaccine can prevent almost 100% of disease caused by the 4 types of HPV targeted by the vaccine. However, if a girl or woman is already infected with a type of HPV, the vaccine will not prevent disease from that type.
The vaccine is also recommended for girls and women 13-26 years of age who did not receive it when they were younger.
HPV vaccine is given as a 3-dose series:
Additional (booster) doses are not recommended.
HPV vaccine may be given at the same time as other vaccines.
Which girls or women should not get HPV vaccine or should wait?
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Anyone who has ever had a life-threatening allergic reaction to yeast, to any other component of HPV vaccine, or to a previous dose of HPV vaccine should not get the vaccine. Tell your doctor if the person getting the vaccine has any severe allergies.
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Pregnant women should not get the vaccine. The vaccine appears to be safe for both the mother and the unborn baby, but it is still being studied. Receiving HPV vaccine when pregnant is not a reason to consider terminating the pregnancy. Women who are breast feeding may safely get the vaccine.
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Any woman who learns that she was pregnant when she got HPV vaccine is encouraged to call the HPV vaccine in pregnancy registry at 800-986-8999. Information from this registry will help us learn how pregnant women respond to the vaccine.
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People who are mildly ill when the shot is scheduled can still get HPV vaccine. People with moderate or severe illnesses should wait until they recover.
What are the risks from HPV vaccine?
HPV vaccine does not appear to cause any serious side effects.
However, a vaccine, like any medicine, could possibly cause serious problems, such as severe allergic reactions. The risk of any vaccine causing serious harm, or death, is extremely small.
Mild Problems:
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Pain at the injection site (about 8 people in 10)
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Redness or swelling at the injection site (about 1 person in 4)
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Mild fever (100°F) (about 1 person in 10)
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Itching at the injection site (about 1 person in 30)
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Moderate fever (102°F) (about 1 person in 65)
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These symptoms do not last long and go away on their own.
Life-threatening allergic reactions from vaccines are very rare. If they do occur, it would be within a few minutes to a few hours after the vaccination.
Like all vaccines, HPV vaccine will continue to be monitored for unusual or severe problems.
What if there is a severe reaction?
What should I look for?
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Any unusual condition, such as a high fever or behavior changes. Signs of a serious allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness.
What should I do?
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Call a doctor, or get the person to a doctor right away.
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Tell your doctor what happened, the date and time it happened, and when the vaccination was given.
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Ask your health care provider to file a Vaccine Adverse Event Reporting System (VAERS) form if you have any reaction to the vaccine. Or call VAERS yourself at 1-800-822-7967, or visit their website at http://vaers.hhs.gov.
The National Vaccine Injury Compensation Program
In the rare event that you or your child has a serious reaction to a vaccine, a federal program has been created to help pay for the care of those who have been harmed.
For details about the National Vaccine Injury Compensation Program, call 1-800-338-2382 or visit the program's website at http://www.hrsa.gov/vaccinecompensation.
How can I learn more?
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Ask your doctor or other health care provider. They can give you the vaccine package insert or suggest other sources of information.
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Call your local or state health department's immunization program.
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Contact the Centers for Disease Control and Prevention (CDC): call 1-800-232-4636 (1-800-CDC-INFO) or visit the National Immunization Program's website at http://www.cdc.gov/vaccines.
HPV Vaccine Information Statement. U.S. Department of Health and Human Services/Centers for Disease Control and Prevention National Immunization Program. 2/2/2007.
- 4: CMAJ. 2007 Aug 28;177(5):469-79. Epub 2007 Aug 1.
Prophylactic vaccination against human papillomavirus infection and disease in women: a systematic review of randomized controlled trials.
Rambout L, Hopkins L, Hutton B, Fergusson D.
Department of Pharmacy, The Ottawa Hospital, Ottawa, Ont. lrambout@ottawahospital.on.ca
BACKGROUND: Human papillomavirus (HPV) is now known to be a necessary cause of cervical cancer, and prophylactic HPV vaccines aimed at preventing genital warts, precancerous cervical lesions and cervical cancer are now available. To gauge the potential impact on disease burden, we performed a systematic review of the evidence from randomized controlled trials. METHODS: We conducted a systematic search of the literature to identify all randomized controlled trials of prophylactic HPV vaccination. Reports in 5 electronic databases covering 1950 to June 2007 (MEDLINE, MEDLINE in process, EMBASE, the Cochrane Central Registry of Controlled Trials and the Cochrane Library), bibliographies of all included studies and of narrative reviews (2006-2007), clinical trial registries, Google Scholar, public health announcements, selected conference proceedings (2004-2007) and manufacturers' information on unpublished data or ongoing trials were screened against predefined eligibility criteria by 2 independent reviewers. Vaccines had to contain coverage against at least 1 oncogenic HPV strain. The primary outcome of interest was the frequency of high-grade cervical lesions (high-grade squamous intraepithelial lesion, or grade 2 or 3 cervical intraepithelial neoplasia). The secondary outcomes were persistent HPV infection, low-grade cervical lesions (low-grade squamous intraepithelial lesion or grade 1 cervical intraepithelial neoplasia), external genital lesions, adverse events and death. Meta-analysis of the data was done in all cases where adequate clinical and methodological homogeneity existed. RESULTS: Of 456 screened reports, 9 were included in the review (6 were reports of randomized controlled trials and 3 were follow-up reports of initial trials). Findings from the meta-analysis showed that prophylactic HPV vaccination was associated with a reduction in the frequency of high-grade cervical lesions caused by vaccine-type HPV strains compared with control groups: Peto odds ratio 0.14 (95% confidence interval [CI] 0.09-0.21) from combined per-protocol analyses, and 0.52 (95% CI 0.43-0.63) from modified intention-to-treat analyses. Vaccination was also highly efficacious in preventing other HPV-related infection and disease outcomes, including persistent HPV infection, low-grade lesions and genital warts. The majority of adverse events were minor. The incidence of serious adverse events and death were balanced between the vaccine and control groups. INTERPRETATION: Among women aged 15-25 years not previously infected with vaccine-type HPV strains, prophylactic HPV vaccination appears to be highly efficacious in preventing HPV infection and precancerous cervical disease. Long-term follow-up is needed to substantiate reductions in cervical cancer incidence and mortality.
PMID: 17671238 [PubMed - indexed for MEDLINE]
E se ne volete sapere di più basta cliccare sui seguenti links..
Related Links
Human papilloma virus (HPV) prophylactic vaccination: challenges for public health and implications for screening. [Vaccine. 2007] The impact of anti HPV vaccination on cervical cancer incidence and HPV induced cervical lesions: consequences for clinical management. [Eur J Gynaecol Oncol. 2005] [Cervical cancer prevention: the impact of HPV vaccination] [Gynecol Obstet Fertil. 2006] Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). [MMWR Recomm Rep. 2007]
Grazie di cuore al professor Formiconi che mi ha dato l'opportunità di dire finalmente alcune delle cose che volevo dire da tanto, di avermi incoraggiato a costruire questo blog e di avermi aperto molte strade nel mondo di Internet. Questa esperienza mi ha fatto conoscere un pò delle infinite risorse della rete, da Delicious ai Reader, da Anobii a Pub Med. Continuerò sicuramente ad usare questi strumenti soprattutto Anobii in cui sguazzo alla meraviglia e Pub Med che sarà sempre utile negli studi e nella carriera futura. Ho conosciuto molte persone, ho imparato a condividere e a comunicare. E adesso mi sento più a mio agio e più consapevole quando accendo il computer.